KNGF Guideline Cardiac rehabilitation

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KNGF Clinical Practice Guideline for physical therapy in patients undergoing cardiac rehabilitation Practice Guidelines Table 10. Evaluation and screening instruments for each goal in physical therapy for chronic heart failure. goal final outcome evaluation instrument when specific physical goals I. optimizing exercise capacity Exercise capacity is at optimum or target level for this patient by physician • maximum or symptom-limited exercise test with gas analysis plus Borg RPE scale (6–20); possibly scoring Anxiety, Angina and/or Dyspnea scales maximum or symptom-limited exercise test with gas analysis and KVL-H questionnaire at start and end of training program by cardiac rehabilitation coordinator • subjective physical score on KVL-H questionnaire Functional exercise capacity is at optimum or target level. by physical therapist • as for goals 1 and 2 • (modified) SWT • possibly MET method and/or SAS at start, every 4 weeks and at end of training program II. balancing exertion with physical abilities Patient (and partner) coping effectively with symptoms, that is, patient avoids excessive strain and (if possible) improves exercise capacity (goal 1). Patient is able to spread their energy expenditure and to deal with their dyspnea in a functional way. • compare subjective exercise capacity score with objective score • ask for 5 most problematic activities (PSC) and score these on the Borg RPE scale (6–20); possibly score Anxiety and/or Angina and/or Dyspnea scales at start and end of rehabilitation and / or training program, but also continuous evaluation to check for excessive strain III. reducing fatigue, dyspnea and inactivity Patient’s sensation of dyspnea is at optimum or target level. Patient has adopted a physically active lifestyle. • Borg RPE scale (6–20) and Dyspnea scale for fatigue and dyspnea • Monitor Bewegen en Gezondheid, see goal 4 (www.tno.nl) (in Dutch) at start and at end of rehabilitation and / or training program general physical goals 1. exploring one’s own physical limits 2. learning to cope with physical limitations Patient is aware of their own physical limits, that is, they know what level of physical exertion is possible. Patient is able to cope with their physical limitations and utilize their limited energy efficiently, and has achieved a balance between exertion and relaxation. • ask for 5 most problematic activities (PSC) • ask patient to carry out problematic activities and possibly score them for duration and quality, or using the Anxiety and / or Angina and / or Dyspnea scales. • score using Borg RPE scale (6–20) for fatigue and dyspnea, if indicated at start and end of rehabilitation and / or training program; monitoring heart rate, measuring blood pressure and scoring on Borg scale before, during and after each session V-08/2011 22
KNGF Clinical Practice Guideline for physical therapy in patients undergoing cardiac rehabilitation Practice Guidelines Table 10. Continued. goal final outcome evaluation instrument when 3. overcoming fear of exertion Patient is no longer afraid of exertion. • history-taking and observation • questionnaire: see Multidisciplinaire Richtlijn Hartrevalidatie 2011 (www.nvvc.nl) (2011 Dutch multidisciplinary guideline on cardiac rehabilitation) (in Dutch) at start and end of rehabilitation and / or training program 4. het ontwikkelen van een actieve leefstijl Patient has adopted an active lifestyle or is able to keep up the most active achievable lifestyle (NYHA Class III). • history-taking (motivational interviewing) • Monitor Bewegen en Gezondheid (www.tno.nl) (in Dutch) • post-rehabilitation activities started at start and at end of rehabilitation and / or training program Focal points acquiring information about healthy living and secondary prevention Patient knows about healthy living and secondary prevention. • checklist for risk factors / unhealthy behavior • Phase III activities started • ability to cope effectively with symptoms • ability to recognize signs of decompensation at start and at end of rehabilitation and / or training program goals of relaxation program Patients is familiar with the relaxation program and is able to relax. • evaluation list • using a flowchart: See Verantwoording en toelichting (review of the evidence; in Dutch) Section B.3.3 (www.kngfrichtlijnen.nl) at interim and final evaluation of rehabilitation and / or relaxation program Borg RPE scale = Borg Rating of Perceived Exertion; KVL-H = Kwaliteit van Leven vragenlijst voor Hartpatiënten (Dutch quality of life questionnaire for heart patients); 6MWT = 6-Minute walking test; MET = metabolic equivalent of task; PSC = Patient-specific complaints; SAS = Specific activity scale; SWT = Shuttle walk test. C Reporting, concluding the treatment and record-keeping The physical therapist must report to the cardiac rehabilitation team about the treatment process, the treatment outcomes and the recommendations (aftercare). This should happen at least at the end of the treatment, but possibly also during the treatment period. In addition, the physical therapist also informs the patient’s cardiologist, family physician and, if applicable, their rehabilitation physician or company doctor. The cardiac rehabilitation program is then either continued or concluded, after consultation with the rehabilitation team. Acknowledgments The draft guideline was commented on by a group of external experts. The guideline development team gratefully acknowledges the contributions by: Rob Bertram, Jan van Dixhoorn, Marleen Buruma and Erik Hulzebos. Rob Bertram works as a physical therapist at Groningen University Medical Center’s Rehabilitation Center, located at Beatrixoord. Marleen Buruma works as a physical therapist / course instructor / coordinator of professional development at the Dutch Institute of Allied Health, Amersfoort. Jan van Dixhoorn is physician and instructor at the Kennemer Gasthuis hospital in Haarlem. Erik Hulzebos is a clinical exercise physiologist at the Child Development and Exercise Center of the Wilhelmina Children’s Hospital, University Medical Center Utrecht. The team would also like to thank Jaap Donkers for his assistance in drafting the description of the preoperative phase and the physical therapy recommendations for coronary heart disease. In addition, the guideline development team would like to thank the authors involved in developing the previous edition of this Guideline: Lisette Vogels, Jean Graus, Rob van Hulst, Frank Nusman, Roelof Peters and Bart Smit. In addition, a debt of gratitude is owed to Ms. M.R. Kruyswijk, editor of the KNGF guidelines. The inclusion of the above persons as consultants does not imply that each of them agrees with every detail of the Guideline. V-08/2011 23
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KNGF Guideline Cardiac rehabilitation

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